Provider Demographics
NPI:1558798058
Name:THE RYDER CLINIC, LLC
Entity Type:Organization
Organization Name:THE RYDER CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:225-766-9788
Mailing Address - Street 1:6060 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 424
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5209
Mailing Address - Country:US
Mailing Address - Phone:225-766-9788
Mailing Address - Fax:
Practice Address - Street 1:6555 PERKINS RD
Practice Address - Street 2:STE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4237
Practice Address - Country:US
Practice Address - Phone:225-766-9788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1594111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty